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Related Experiment Videos

TMS measures of motor cortex function after stroke: A meta-analysis.

Michelle N McDonnell1, Cathy M Stinear2

  • 1School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.

Brain Stimulation
|April 8, 2017
PubMed
Summary

This meta-analysis found stroke primarily affects the excitability of the affected hemisphere. Facilitating affected motor cortex excitability may be more beneficial for post-stroke recovery than suppressing the unaffected hemisphere.

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Neuromodulation

Background:

  • Stroke impacts corticomotor excitability, intracortical function, and interhemispheric interactions.
  • The interhemispheric inhibition model suggests rebalancing these factors aids motor recovery.
  • Current neuromodulation strategies aim to modulate hemispheric excitability, but evidence is inconclusive.

Purpose of the Study:

  • To compare measures of corticomotor excitability, intracortical function, and interhemispheric inhibition in stroke patients versus healthy adults.
  • To analyze differences between affected and unaffected hemispheres in stroke patients.
  • To evaluate the influence of time post-stroke on these neurophysiological measures.

Main Methods:

  • A systematic literature search identified 112 studies from 844 initially screened.
Keywords:
MotorStrokeTranscranial magnetic stimulationUpper limb

Related Experiment Videos

  • Transcranial magnetic stimulation (TMS) measures of the motor cortex were analyzed.
  • Meta-analyses used a random effects model, comparing hemispheres and grouping by time post-stroke (<3 months, ≥6 months).

    • Main Results:

    • Affected hemisphere M1 (motor cortex) excitability is reduced post-stroke compared to unaffected and healthy controls.
    • Short-interval intracortical inhibition (SICI) is reduced in the affected hemisphere early post-stroke but not in the chronic phase.
    • No significant differences were found between the unaffected hemisphere and healthy controls, nor clear effects on interhemispheric inhibition.

    Conclusions:

    • Neurophysiological effects of stroke are largely confined to the affected hemisphere.
    • Evidence does not support unaffected hemisphere hyper-excitability or imbalanced interhemispheric inhibition post-stroke.
    • Directly facilitating affected M1 excitability may be a more effective strategy for promoting motor recovery after stroke.